One of the most widely used treatments for childhood eczema may not actually be helpful, according to UK researchers.
A study, led by the University of Southampton, has found that pouring emollient additives into the bath do not add any benefit over standard management.
“The findings from this trial show that pouring bath emollients into the bath water doesn’t really help children with eczema”
The study – titled Bath additives for the treatment of childhood eczema (BATHE) – was a multi-centre trial also involving the University of Bristol, Cardiff University and the University of Nottingham.
Published in the British Medical Journal, the study involved 482 children from 96 general practices, making it by far the largest trial of emollient bath additives to date.
Children were randomly allocated to two groups, with one group asked to use bath additives for a whole year and the other asked not to use them for a whole year.
Families completed short questionnaires weekly for the first 16 weeks, then every four weeks from 16 to 52 weeks.
“Parents would be better off directing their energies at using leave-on emollients and avoiding soap”
The study, funded by the National Institute for Health Research, found there was no meaningful difference in eczema severity between the groups over the year.
There was also no difference in the number of problems experienced with bathing, like stinging or redness following the bath, which affected a third of children in both groups.
The researchers noted that standard management of childhood eczema included soap avoidance, leave-on emollients and corticosteroid ointments.
Families of children with eczema are advised to continue to use these treatments, they said, adding that pouring emollient bath additives into the bath water was very unlikely to offer extra benefit.
Lead study author Dr Miriam Santer, from Southampton University, said: “The findings from this trial show that pouring bath emollients into the bath water doesn’t really help children with eczema and parents would be better off directing their energies at using leave-on emollients and avoiding soap.
“This is good news, as it gets us one step closer to knowing how best to advise parents of children with eczema, although many research questions remain on other aspects of eczema treatments,” she said.
“If bath emollients are used, it is essential that they are used in addition to, not instead of emollient creams”
John Smith, chief executive of the Proprietary Association of Great Britain, said: “It is important to note that this trial did not look at the use of bath additives in isolation and the authors themselves acknowledge that they cannot rule out the possibility that bath additives can offer benefits to children when used more than five times a week. The trial also did not look at the effectiveness of these products in children under five with eczema.
“The National Institute for Health and Care Effectiveness guidance currently recommends the regular use of emollient wash products for children with eczema as part of a treatment regime, to help reduce symptoms and make children feel more comfortable,” he said. “However, if bath emollients are used, it is essential that they are used in addition to, not instead of emollient creams.
“It is also reassuring to hear that this study found evidence that leave-on emollients and soap substitutes used to treat eczema were effective in reducing inflammation and irritation, highlighting further the benefits these products can offer patients,” noted Mr Smith.